促性腺激素释放激素联合腹腔镜对子宫内膜异位症患者性激素水平及脂氧素A4的影响

Effect of GnRH-α combined with laparoscopy on sex hormone level and LXA4 in patients with endometriosis

目的探讨促性腺激素释放激素(GnRH-α)联合腹腔镜对子宫内膜异位症(EMT)患者性激素水平、脂氧素A4(LXA4)水平的影响。方法选择83例子宫内膜异位症患者,随机数字表法将患者分为两组,联合组(n=42例)采用GnRH-α联合腹腔镜治疗,对照组(n=41例)采用腹腔镜治疗。对比两组疗效和安全性、治疗前后性激素水平[卵泡雌激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]、LXA4水平的差异,并应用改良Kupperman评分比较两组患者更年期症状的差异。结果联合组患者治疗有效率高于对照组(92.86%vs 73.17%,P<0.05),复发率低于对照组(2.38%vs 24.39%,P<0.05)。联合组治疗后FSH、LH、E2、T水平显著下降(P<0.05),且低于对照组[(5.82±1.73)IU/Lvs(6.72±2.02)IU/L、(4.36±1.99)IU/Lvs(6.23±2.27)IU/L、(66.04±7.06)pg/mLvs(84.23±9.09)pg/mL、(2.50±0.31)nmol/Lvs(3.60±0.35)nmol/L,P<0.05]。联合组治疗后血清LXA4水平明显升高(P<0.05),高于对照组[(442.01±35.88)pg/mLvs(362.01±29.13)pg/mL,P<0.05]。联合组治疗后改良Kupperman评分低于对照组[(8.05±1.35)分vs(10.25±2.06)分,P<0.05],治疗后性欲减退率低于对照组(7.14%vs 29.27%,P<0.05),不良反应发生率高于对照组(14.29%vs 0,P<0.05)。结论 GnRH-α联合腹腔镜可显著降低EMT患者性激素水平,上调LXA4表达,提高临床疗效,降低复发,并可显著改善患者临床症状,提高生活质量。

Objective To investigate the clinical efficacy of gonadotropin releasing hormone(GnRH-α) combined with laparoscopy on the levels of sex hormone and lipoxin A4(LXA4) in patients with endometriosis(EMT). Methods Eighty-three patients with endometriosis were divided into two groups by random number table. The combined group(n=42) was treated by GnRH-α combined with laparoscopy, and the control group(n=41) was treated by laparoscopy. The efficacy and safety, sex hormone levels, including follicular estrogen(FSH), luteinizing hormone(LH), estradiol(E2) and testosterone(T), and LXA4 levels before and after treatment were compared between the two groups. The quality of life and climacteric symptoms of the two groups were compared by using the comprehensive quality of life questionnaire and improved Kupperman score. Results The effective rate of treatment in the combined group was significantly higher than that in the control group(92.86% vs. 73.17%, P<0.05), and the recurrence rate was significantly lower than that in the control group(2.38% vs. 24.39%, P<0.05). The levels of FSH, LH, E2 and T in the combined group significantly decreased after treatment(P<0.05), and were lower than those in the control group(5.82±1.73 IU/L vs. 6.72±2.02 IU/L, 4.36±1.99 IU/L vs. 6.23±2.27 IU/L, 66.04±7.06 pg/mL vs. 84.23±9.09 pg/mL, 2.50±0.31 nmol/L vs. 3.60±0.35 nmol/L, P<0.05). The level of serum LXA4 in the combined group was significantly increased after treatment(P<0.05), and was significantly higher than that in the control group(442.01±35.88 pg/mL vs. 362.01±29.13 pg/mL, P<0.05). After treatment, the improved Kupperman score in the combined group was significantly lower than that in the control group(8.05±1.35 vs. 10.25±2.06, P<0.05), the rate of sexual desire decline in the combined group was significantly lower than that in the control group(7.14% vs. 29.27%, P<0.05), but the incidence of adverse reactions was higher than that in the control group(14.29% vs. 0.00%, P<0.05). Conclusion GnRH-α combined with laparoscopy can significantly reduce the level of sex hormones in EMT patients, increase the expression of LXA4, improve clinical efficacy, reduce recurrence, and significantly improve the clinical symptoms and quality of life of EMT patients.